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Unanswered Questions Remain Regarding SBRT in Gastrointestinal Cancers

Amol K. Narang, MD
Published Online:9:16 PM, Mon September 23, 2019

Amol K. Narang, MD, assistant professor of radiation oncology and molecular radiation sciences at John Hopkins Medicine, discusses the unanswered questions that still need to be addressed to further expand the role of stereotactic body radiation therapy (SBRT) in gastrointestinal (GI) cancers. Pancreatic cancer, in particular, poses additional challenges compared with other GI cancers, Narang says.

Investigators question how SBRT fits in the treatment landscape with nonoperative therapies, such as transarterial chemoembolization (TACE). Narang says these 2 therapies may need to be compared, but there may also be rationale to combine both SBRT and TACE in some GI cancers.

Other remaining questions focus on molecular signals that can help in determining which patients will respond best to SBRT. However, Narang says there are more questions in the pancreatic cancer space as well. Pancreatic tumors tend to be against the bowel, which is very sensitive to radiation, but the dose that the bowel can tolerate is too low to gain control of the tumor. More research is necessary to determine how to deliver more radiation to these tumors. Narang says a number of different approaches are being evaluated now that could be valuable to pancreatic cancer treatment.
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